Sarcoid heart disease: rates of arrhythmias, implantable cardiac devices and endomyocardial biopsy

Abstract

Abstract Introduction/Background Sarcoidosis is a granulomatous disease with various cardiac manifestations such as arrhythmias, heart block, heart failure and sudden cardiac death. Objective We sought to determine and compare the rates of arrhythmias, implantable cardiac devices in patient with sarcoid heart disease (SHD) after excluding those with a history of coronary artery disease Methods The United States Nationwide Inpatient Sample was queried from 2010 to 2014 using ICD-9 diagnosis code (135) for sarcoidosis among patients >18 years. We combined it with code (425.8) for cardiomyopathy in others disease including sarcoid and sarcoid heart muscle disease. We excluded patients with a history of prior myocardial infarction, percutaneous coronary intervention and coronary artery bypass graft. Results From 2010 to 2014, we identified 9,063 patients with SHD (Mage = 53.11±11.28 years; men 51.8% and black 52.5%). The overall in-hospital mortality rate was 227 (2.5%). Average Length of stay (LOS) (M ± SD) was 6.15±8.964. Various arrhythmias include atrial fibrillation 1,659 (18.4%), ventricular fibrillation 223 (2.5%), ventricular tachycardia 2,248 (24.7%), complete heart block 506 (1.5%) and second degree Mobitz type II 45 (0.5%). Rates of implantable cardiac devices included implantable cardioverter-defibrillator (ICD) 881 (9.7%), Cardiac Resynchronization Therapy Defibrillator (CRT-D) 83 (3.6%), PPM 172 (1.9%). Rates of Endomyocardial biopsy were 257 (2.8%). Overall rates of sudden cardiac arrest was 161 (1.8%). On comparing the two groups, sarcoidosis without cardiac involvement and sarcoid heart disease the rates of arrhythmias, implantable cardiac devices, in-hospital mortality and sudden cardiac arrest were as follows: atrial fibrillation (9.4 vs 18.3; p<0.001), ventricular fibrillation (0.1 vs 2.5; p<0.001), ventricular tachycardia (1.3 vs 24.8; p<0.001), complete heart block were (0.3 vs 5.6; p<0.001), and second degree Mobitz type II (0.1 vs 0.5; p<0.001), Pacemaker (0.4 vs 1.9; p<0.001), ICD (0.2 vs 9.7; p<0.001), CRT-D (0.1 vs 3.6; p<0.001), in-hospital mortality (2.5 vs 2.5; p=0.8), Sudden cardiac arrest (0.6 vs 1.8; p<0.001). Conclusions Based on the results of our study, we conclude that SHD is associated with a variety of cardiac arrhythmias and conduction defects. Sarcoidosis with cardiac involvement is associated with increased rates of atrial fibrillation, ventricular fibrillation, ventricular tachycardia, complete heart block, and second degree Mobitz type II. They also had a higher rate of pacemaker implantation, ICD, CRT-D and had a overall higher rate of sudden cardiac arrest. Based on the results of our study we conclude that sarcoidosis with cardiac involvement has worse outcomes and hence, early diagnosis and prompt treatment can prevent the progression of the disease. Funding Acknowledgement Type of funding source: None